Monthly Remittance Of Tax On Meals - Virginia Commissioner Of The Revenue

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OFFICE OF THE COMMISSIONER OF THE REVENUE
CITY OF FREDERICKSBURG, VIRGINIA
Phone (540) 372-1004
MONTHLY REMITTANCE OF TAX ON
MEALS
TRADE NAME
FEIN:
CORP NAME
ADDRESS
CITY STATE ZIP
1. Gross receipts for the month of ________________ 20____ ...............................$_________________
2. Less allowable deductions (attach list) .................................................................$_________________
3. Balance Taxable ....................................................................................................$_________________
4. 6% tax on item 3 ...................................................................................................$_________________
5. Less seller’s discount on item 4 (3% OR $100, whichever is LESS)
...............$_________________
DISCOUNT AVAILABLE ONLY WHEN FILED & PAID ON TIME
6. Balance – total tax less sellers discount ................................................................$_________________
7. Penalty for late payment – 10 % of item 6 or $2.00 (
)..$_________________
WHICHEVER IS GREATER
8 Total Tax and Penalty ...........................................................................................$_________________
9. 10 % per annum interest on tax and penalty .........................................................$_________________
10. Total Tax, Penalty and Interest due and paid herewith .......................................$_________________
MAKE CHECK PAYABLE TO CITY TREASURER
DECLARATION OF SELLER:
I hereby swear or affirm that the amounts listed above are true, correct and complete to the best of my
knowledge and belief for the period stated above.
Date ________________________________
Signature _________________________________
Phone No. ___________________________
Title ______________________________________
INSTRUCTIONS: Mail original copy with check payable to City Treasurer on or before the
th
20
day of the month following the month being reported, to:
Commissioner of the Revenue, P O Box 644, City Hall, Fredericksburg, VA 22404-0644
For Office Use
Received by:
____________________________________
______________________________
Date Received in Office
Commissioner of the Revenue

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